1
|
Faraj KS, Kaufman SR, Herrel LA, Maganty A, Oerline MK, Caram MEV, Shahinian VB, Hollenbeck BK. Urologist practice divestment from radiation vault ownership and treatment patterns for prostate cancer. Cancer 2024; 130:1609-1617. [PMID: 38146764 PMCID: PMC11009074 DOI: 10.1002/cncr.35168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/23/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Urologists practicing in single-specialty groups with ownership in radiation vaults are more likely to treat men with prostate cancer. The effect of divestment of vault ownership on treatment patterns is unclear. METHODS A 20% sample of national Medicare claims was used to perform a retrospective cohort study of men with prostate cancer diagnosed between 2010 and 2019. Urology practices were categorized by radiation vault ownership as nonowners, continuous owners, and divested owners. The primary outcome was use of local treatment, and the secondary outcome was use of intensity-modulated radiation therapy (IMRT). A difference-in-differences framework was used to measure the effect of divestment on outcomes compared to continuous owners. Subgroup analyses assessed outcomes by noncancer mortality risk (high [>50%] vs. low [≤50%]). RESULTS Among 72 urology practices that owned radiation vaults, six divested during the study. Divestment led to a decrease in treatment compared with those managed at continuously owning practices (difference-in-differences estimate, -13%; p = .03). The use of IMRT decreased, but this was not statistically significant (difference-in-differences estimate, -10%; p = .13). In men with a high noncancer mortality risk, treatment (difference-in-differences estimate, -28%; p < .001) and use of IMRT (difference-in-differences estimate, -27%; p < .001) decreased after divestment. CONCLUSIONS Urology group divestment from radiation vault ownership led to a decrease in prostate cancer treatment. This decrease was most pronounced in men who had a high noncancer mortality risk. This has important implications for health care reform by suggesting that payment programs that encourage constraints on utilization, when appropriate, may be effective in reducing overtreatment.
Collapse
Affiliation(s)
- Kassem S Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mary K Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Megan E. V. Caram
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | |
Collapse
|
2
|
Maganty A, Kaufman SR, Oerline MK, Lai LY, Caram MEV, Shahinian VB, Hollenbeck BK. National Trends in Management of Newly Diagnosed Prostate Cancer. Clin Genitourin Cancer 2024; 22:10-17. [PMID: 37468340 DOI: 10.1016/j.clgc.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Deciding whether to treat or conservatively manage patients with prostate cancer is challenging. Recent changes in guidelines, advances in treatment technologies, and policy can influence decision making surrounding management, particularly for those for whom the decision to treat is discretionary. Contemporary trends in management of newly diagnosed prostate cancer are unclear. METHODS Using national Medicare data, men with newly diagnosed prostate cancer were identified between 2014 and 2019. Patients were classified by 5- and 10-year noncancer mortality risk. Multinomial logistic regression models were fit to assess adjusted trends in management over time. The primary outcome was management of prostate cancer: local treatment (inclusive of surgery, radiation, brachytherapy, or cryotherapy), hormone therapy, or observation. RESULTS Local treatment was the most common form of management and stable across years (68%). Use of observation increased (21%-23%, P < .001) and use of hormone therapy decreased (11%-8%, P < 0.001). After stratifying by 10-year non-cancer mortality risk, observation increased among men with low (22.3%-26.1%, P < .001) and moderate (19.9%-23.5%, P < .001) mortality risk. Conversely, use of treatment increased among those with high (62.8%-68.0%, P = .004) and very high (45.5%-54.1%, P < .001) risk of noncancer mortality. These trends were similar across groups when stratified by 5-year noncancer mortality risk. CONCLUSION Nationally, use of local treatment remains common and was stable throughout the study period. However, while local treatment declined among men with a lower risk of noncancer mortality, it increased among men with a higher risk of non-cancer mortality.
Collapse
Affiliation(s)
- Avinash Maganty
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Samuel R Kaufman
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mary K Oerline
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Lillian Y Lai
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Megan E V Caram
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Vahakn B Shahinian
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Brent K Hollenbeck
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| |
Collapse
|
3
|
Faraj KS, Kaufman SR, Oerline M, Herrel LA, Maganty A, Caram MEV, Shahinian VB, Hollenbeck BK. The 340B Program and oral specialty drugs for advanced prostate cancer. Cancer 2024. [PMID: 38395607 DOI: 10.1002/cncr.35262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Expensive oral specialty drugs for advanced prostate cancer can be associated with treatment disparities. The 340B program allows hospitals to purchase medications at discounts, generating savings that can improve care of the socioeconomically disadvantaged. This study assessed the effect of hospital 340B participation on advanced prostate cancer. METHODS The authors performed a retrospective cohort study of Medicare beneficiaries with advanced prostate cancer from 2012 to 2019. The primary outcome was use of an oral specialty drug. Secondary outcomes included monthly out-of-pocket costs and treatment adherence. We evaluated the effects of 1) hospital 340B participation, 2) a regional measure vulnerability, the social vulnerability index (SVI), and 3) the interaction between hospital 340B participation and SVI on outcomes. RESULTS There were 2237 and 1100 men who received care at 340B and non-340B hospitals. There was no difference in specialty drug use between 340B and non-340B hospitals, whereas specialty drug use decreased with increased SVI (odds ratio, 0.95, p = .038). However, the interaction between hospital 340B participation and SVI on specialty drug use was not significant. Neither 340B participation, SVI, or their interaction were associated with out-of-pocket costs. Although hospital 340B participation and SVI were not associated with treatment adherence, their interaction was significant (p = .020). This demonstrated that 340B was associated with better adherence among socially vulnerable men. CONCLUSIONS The 340B program was not associated with specialty drug use in men with advanced prostate cancer. However, among those who were started on therapy, 340B was associated with increased treatment adherence in more socially vulnerable men.
Collapse
Affiliation(s)
- Kassem S Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan E V Caram
- VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
4
|
Maganty A, Shah AA, Hill D, Golla V. Financial Implications of the Merit-Based Incentive Payment System for Surgical Health Care Professionals. JAMA Surg 2024; 159:221-223. [PMID: 37991752 PMCID: PMC10867682 DOI: 10.1001/jamasurg.2023.5638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/24/2023] [Indexed: 11/23/2023]
Abstract
This study describes financial implications of the merit-based incentive payment system for surgical health care professionals.
Collapse
Affiliation(s)
- Avinash Maganty
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Anup A. Shah
- Santa Clara Valley Medical Center, San Jose, California
| | - Dawson Hill
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Vishnukamal Golla
- Duke National Clinician Scholars Program, Durham, North Carolina
- Division of Urology, Duke Department of Surgery, Durham, North Carolina
- Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Section of Urology, Durham Veterans Affairs Health Care System, Durham, North Carolina
| |
Collapse
|
5
|
Maganty A, Kaufman SR, Oerline MK, Faraj K, Caram ME, Shahinian VB, Hollenbeck BK. Association Between Urologist Merit-Based Incentive Payment System Performance and Quality of Prostate Cancer Care. Urol Pract 2024; 11:207-214. [PMID: 37748132 PMCID: PMC10842494 DOI: 10.1097/upj.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION We performed a study to evaluate the association between urologist performance in the Merit-Based Incentive Payment System (MIPS), and quality and spending for prostate cancer care. METHODS Medicare beneficiaries with prostate cancer diagnosed between 2017 and 2019 were assigned to their primary urologist. Associated MIPS scores were identified and categorized based on thresholds for payment adjustment as low (worst), moderate, and high (best). Multivariable mixed effects models were used to measure the association between MIPS performance and adherence to quality measures and price standardized spending for prostate cancer. RESULTS Adherence to quality measures did not vary across MIPS performance groups for pretreatment counselling by both a urologist and radiation oncologist (low-76%, [95% CI 73%-80%], moderate-77% [95% CI 74%-79%], and high-75% [95% CI 74%-76%]) and avoiding treatment in men with a high risk of noncancer mortality within 10 years of diagnosis (low-40% [95% CI 35%-45%], moderate-39% [95% CI 36%-43%], high-38% [95% CI 36%-39%]). Men on active surveillance managed by high performers more likely received a confirmatory test (44% [95% CI 43%-46%]) compared to those managed by moderate (38% [95% CI 33%-42%]) performers, but not low performers (36% [95% CI 29%-44%]). There was no difference in adjusted spending across MIPS performance groups. CONCLUSIONS Better performance in MIPS is associated with a higher rate of confirmatory testing in men initiating active surveillance for prostate cancer. However, performance was not associated with other dimensions of quality nor spending.
Collapse
Affiliation(s)
- Avinash Maganty
- University of Michigan, Department of Urology, Division of Health Services Research
| | - Samuel R. Kaufman
- University of Michigan, Department of Urology, Division of Health Services Research
| | - Mary K. Oerline
- University of Michigan, Department of Urology, Division of Health Services Research
| | - Kassem Faraj
- University of Michigan, Department of Urology, Division of Health Services Research
| | - Megan E.V. Caram
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Vahakn B. Shahinian
- University of Michigan, Department of Urology, Division of Health Services Research
- Division of Nephrology, Department of Internal Medicine, University of Michigan
| | | |
Collapse
|
6
|
Maganty A, Kaufman SR, Oerline MK, Faraj KS, Caram MEV, Shahinian VB, Hollenbeck BK. Value-based payment models and management of newly diagnosed prostate cancer. Cancer Med 2023; 13:e6810. [PMID: 38146905 PMCID: PMC10807592 DOI: 10.1002/cam4.6810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE To examine the effect of urologist participation in value-based payment models on the initial management of men with newly diagnosed prostate cancer. METHODS Medicare beneficiaries with prostate cancer diagnosed between 2017 and 2019, with 1 year of follow-up, were assigned to their primary urologist, each of whom was then aligned to a value-based payment model (the merit-based incentive payment system [MIPS], accountable care organization [ACO] without financial risk, and ACO with risk). Multivariable mixed-effects logistic regression was used to measure the association between payment model participation and treatment of prostate cancer. Additional models estimated the effects of payment model participation on use of treatment in men with very high risk (i.e., >75%) of non-cancer mortality within 10 years of diagnosis (i.e., a group of men for whom treatment is generally not recommended) and price-standardized prostate cancer spending in the 12 months after diagnosis. RESULTS Treatment did not vary by payment model, both overall (MIPS-67% [95% CI 66%-68%], ACOs without risk-66% [95% CI 66%-68%], ACOs with risk-66% [95% CI 64%-68%]). Similarly, treatment did not vary among men with very high risk of non-cancer mortality by payment model (MIPS-52% [95% CI 50%-55%], ACOs without risk-52% [95% CI 50%-55%], ACOs with risk-51% [95% CI 45%-56%]). Adjusted spending was similar across payment models (MIPS-$16,501 [95% CI $16,222-$16,780], ACOs without risk-$16,140 [95% CI $15,852-$16,429], ACOs with risk-$16,117 [95% CI $15,585-$16,649]). CONCLUSIONS How urologists participate in value-based payment models is not associated with treatment, potential overtreatment, and prostate cancer spending in men with newly diagnosed disease.
Collapse
Affiliation(s)
- Avinash Maganty
- Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Samuel R. Kaufman
- Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Mary K. Oerline
- Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Kassem S. Faraj
- Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Megan E. V. Caram
- Division of Hematology/Oncology, Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- VA Health Services Research & Development, Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Vahakn B. Shahinian
- Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
- Division of Nephrology, Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Brent K. Hollenbeck
- Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| |
Collapse
|
7
|
Faraj KS, Kaufman SR, Herrel LA, Maganty A, Oerline M, Caram MEV, Shahinian VB, Hollenbeck BK. The immediate effects of private equity acquisition of urology practices on the management of newly diagnosed prostate cancer. Cancer Med 2023; 12:22325-22332. [PMID: 38100144 PMCID: PMC10757152 DOI: 10.1002/cam4.6788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/22/2023] [Accepted: 11/23/2023] [Indexed: 12/31/2023] Open
Abstract
INTRODUCTION Some worry that physician practices acquired by private equity may increase the use of services to maximize revenue. We assessed the effects of private equity acquisition on spending, use of treatment, and diagnostic testing in men with prostate cancer. METHODS We used a 20% sample of national Medicare claims to perform a retrospective cohort study of men with prostate cancer diagnosed from 2014 through 2019. The primary outcome was prostate cancer spending in the first 12 months after diagnosis. Secondary outcomes included the use of treatment and a composite measure of diagnostic testing (e.g., imaging, genomics) in the first 12 months after diagnosis. Multilevel modeling was used to adjust for differences in patient and market characteristics. The effect of practice acquisition on each outcome was assessed using a difference-in-differences design. RESULTS There were 409 and 4021 men with prostate cancer managed by urologists in acquired and nonacquired practices, respectively. After acquisition, prostate cancer spending was comparable between acquired and nonacquired practices (difference-in-differences estimate $1182, p = 0.36). Acquisition did not affect the use of treatment (difference-in-differences estimate 3.7%, p = 0.30) or the use of diagnostic testing in men who were treated (difference-in-differences -5.5%, p = 0.12) and those managed conservatively (difference-in-differences -2.0%, p = 0.82). CONCLUSIONS In the year following acquisition of urology practices, private equity did not increase prostate cancer spending, the use of treatment or diagnostic testing in men with prostate cancer. Future work should evaluate the effects of private equity acquisition on practice patterns and quality over a longer time horizon.
Collapse
Affiliation(s)
- Kassem S Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan E V Caram
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Brent K Hollenbeck
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Faraj KS, Kaufman SR, Herrel LA, Maganty A, Oerline M, Caram MEV, Shahinian VB, Hollenbeck BK. Acquisition of Urology Practices by Private Equity Firms and Performance in the Merit-based Incentive Payment System. Urol Pract 2023; 10:597-603. [PMID: 37856709 PMCID: PMC10593488 DOI: 10.1097/upj.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/20/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Private equity is increasingly engaged in the acquisition of urology practices. The implications of strategies to enhance practice value deployed by these firms for patients are unclear. METHODS We conducted a retrospective study of urologist performance in the MIPS (Merit-based Incentive Payment System) program for 2017 to 2020 using national Medicare data from the Quality Payment Program file. The primary outcome was the overall MIPS score. Secondary outcomes included MIPS component scores (ie, quality, interoperability, improvement activities, cost) and the percentage of urologists receiving a bonus payment. Generalized estimating equations were used to estimate the relationship between private equity acquisition and outcomes using a difference-in-differences framework. RESULTS Between 2017 and 2020, 181 urologists were in a urology practice acquired by private equity with MIPS data available the year before and after acquisition. Compared to urologists in practices not acquired by private equity, those in acquired practices had worse overall MIPS performance after acquisition (difference-in-differences estimate, -14 points, P = .04). The decrease in the overall score was driven by worse performance in the quality score (difference-in-differences estimate, -28 points, P < .001). Finally, acquisition resulted in a decrease in the percentage of urologists receiving bonus payments (difference-in-differences estimate, -43%, P < .001). CONCLUSIONS Private equity acquisition of urology practices was associated with significantly lower MIPS performance. As private equity acquisition of urology practices becomes more prevalent, key stakeholders should ensure that the quality of patient care is maintained and that the involvement of for-profit entities in health care is being made transparent to patients.
Collapse
Affiliation(s)
- Kassem S Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Mary Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Megan E V Caram
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brent K Hollenbeck
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
9
|
Faraj KS, Kaufman SR, Herrel LA, Oerline MK, Maganty A, Shahinian VB, Hollenbeck BK. Association between urology practice use of multiparametric MRI and genomic testing and treatment of men with newly diagnosed prostate cancer. Urol Oncol 2023; 41:430.e17-430.e23. [PMID: 37580226 PMCID: PMC10836888 DOI: 10.1016/j.urolonc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Biomarkers for prostate cancer, such as multiparametric MRI (mpMRI) and tissue-based genomics, are increasingly used for treatment decision-making. Using biomarkers indiscriminately and thus ignoring competing risks of mortality may lead to treatment in some men who derive little clinical benefit. We assessed the relationship between urology practice use of biomarkers and subsequent treatment in men with newly diagnosed prostate cancer. METHODS We used a 20% random sample of national Medicare data to perform a retrospective cohort study of men with newly diagnosed prostate cancer diagnosed from 2015 through 2019. Urology practice-level use of biomarkers was characterized based on urology practice propensity to use either biomarker after diagnosis (never, below median, above the median). Noncancer mortality risk within 10 years of diagnosis was calculated for all men. Multilevel models were used to assess the relationship between practice-level biomarker use and treatment by noncancer mortality risk. RESULTS Between 2015 and 2019, 1,764 (65%) urology practices used mpMRI and 897 (33%) used genomic testing for prostate cancer. Compared with urology practices never using each biomarker, those using mpMRI above the median (56% vs. 47%, P = 0.003) and tissue-based genomics below the median (56% vs. 50%, P = 0.03) were more likely to treat men with >75% risk of noncancer mortality. Additionally, compared with urology practices never using either biomarker, use of mpMRI (72% vs. 69%, P = 0.07) or tissue-based genomics (71% vs. 70%, P = 0.65) did not impact treatment in the healthiest group (i.e., those with <25% risk of noncancer mortality). CONCLUSIONS Compared to practices that do not use each biomarker in men with newly diagnosed prostate cancer, urology practices using mpMRI, and tissue-based genomics to a lesser extent, are more likely to treat men at very high risk of dying from competing risks of mortality within 10 years of prostate cancer diagnosis.
Collapse
Affiliation(s)
- Kassem S Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mary K Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | |
Collapse
|
10
|
Maganty A, Hollenbeck BK. New technology in prostate cancer and financial toxicity. Urol Oncol 2023; 41:376-379. [PMID: 37173237 PMCID: PMC10524964 DOI: 10.1016/j.urolonc.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
The management of prostate cancer has significantly evolved over the last few decades with the emergence of new diagnostic and treatment technologies, which are typically more expensive than the previous alternatives. However, decision-making regarding which diagnostics and treatment to pursue is often influenced by perceived benefits, adverse effects, and physician recommendations, without considering the financial liability borne by patients. New technologies may exacerbate financial toxicity by replacing less costly alternatives, promoting unrealistic expectations, and expanding treatment to those who would have previously gone untreated. More judicious use of technologies with an understanding of the contexts in which they are most beneficial may help prevent avoidable financial toxicity to patients.
Collapse
Affiliation(s)
- Avinash Maganty
- Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, MI.
| | - Brent K Hollenbeck
- Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, MI
| |
Collapse
|
11
|
Affiliation(s)
- Rishi R Sekar
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; National Clinician Scholars Program, University of Michigan, Ann Arbor, MI.
| | - Avinash Maganty
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| |
Collapse
|
12
|
Krampe N, Kaufman SR, Oerline MK, Hill D, Caram MEV, Shahinian VB, Hollenbeck BK, Maganty A. Health care delivery system contributions to management of newly diagnosed prostate cancer. Cancer Med 2023; 12:17346-17355. [PMID: 37475511 PMCID: PMC10501260 DOI: 10.1002/cam4.6349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/19/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Despite clinical guidelines advocating for use of conservative management in specific clinical scenarios for men with prostate cancer, there continues to be tremendous variation in its uptake. This variation may be amplified among men with competing health risks, for whom treatment decisions are not straightforward. The degree to which characteristics of the health care delivery system explain this variation remains unclear. METHODS Using national Medicare data, men with newly diagnosed prostate cancer between 2014 and 2019 were identified. Hierarchical logistic regression models were used to assess the association between use of treatment and health care delivery system determinants operating at the practice level, which included measures of financial incentives (i.e., radiation vault ownership), practice organization (i.e., single specialty vs. multispecialty groups), and the health care market (i.e., competition). Variance was partitioned to estimate the relative influence of patient and practice characteristics on the variation in use of treatment within strata of noncancer mortality risk groups. RESULTS Among 62,507 men with newly diagnosed prostate cancer, the largest variation in the use of treatment between practices was observed for men with high and very high-risk of noncancer mortality (range of practice-level rates of treatment for high: 57%-71% and very high: 41%-61%). Addition of health care delivery system determinants measured at the practice level explained 13% and 15% of the variation in use of treatment among men with low and intermediate risk of noncancer mortality in 10 years, respectively. Conversely, these characteristics explained a larger share of the variation in use of treatment among men with high and very high-risk of noncancer mortality (26% and 40%, respectively). CONCLUSIONS Variation among urology practices in use of treatment was highest for men with high and very high-risk noncancer mortality. Practice characteristics explained a large share of this variation.
Collapse
Affiliation(s)
- Noah Krampe
- Dow Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Samuel R. Kaufman
- Dow Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Mary K. Oerline
- Dow Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Dawson Hill
- Dow Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Megan E. V. Caram
- Division of Hematology/Oncology, Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Vahakn B. Shahinian
- Dow Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
- Division of Nephrology, Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Brent K. Hollenbeck
- Dow Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| |
Collapse
|
13
|
Hill D, Kaufman SR, Oerline MK, Faraj K, Caram MEV, Shahinian VB, Hollenbeck BK, Maganty A. In-office dispensing of oral targeted agents by urology practices in men with advanced prostate cancer. JNCI Cancer Spectr 2023; 7:pkad062. [PMID: 37643638 PMCID: PMC10555918 DOI: 10.1093/jncics/pkad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Management of men with advanced prostate cancer has evolved to include urologists, made possible by oral targeted agents (eg, abiraterone or enzalutamide) that can be dispensed directly to patients in the office. We sought to investigate whether this increasingly common model improves access to these agents, especially for Black men who are historically undertreated. METHODS We used 20% national Medicare data to perform a retrospective cohort study of men with advanced prostate cancer from 2011 through 2019, managed by urology practices with and without in-office dispensing. Using a difference-in-difference framework, generalized estimating equations were used to measure the effect of in-office dispensing on prescriptions for abiraterone and/or enzalutamide, adjusting for differences between patients, including race. RESULTS New prescription fills for oral targeted agents increased after the adoption of in-office dispensing (+4.4%, 95% confidence interval [CI] = 3.4% to 5.4%) relative to that for men managed by practices without dispensing (+2.4%, 95% CI = 1.4% to 3.4%). The increase in the postintervention period (difference-in-difference estimate) was 2% higher (95% CI = 0.6% to 3.4%) for men managed by practices adopting dispensing relative to men managed by practices without dispensing. The effect was strongest for practices adopting dispensing in 2015 (difference-in-difference estimate: +4.2%, 95% CI = 2.3% to 6.2%). The effect of dispensing adoption did not differ by race. CONCLUSION Adoption of in-office dispensing by urology practices increased prescription fills for oral targeted agents in men with advanced prostate cancer. This model of delivery may improve access to this important class of medications.
Collapse
Affiliation(s)
- Dawson Hill
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Mary K Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Kassem Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Megan E V Caram
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs (VA) Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Vahakn B Shahinian
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
14
|
Maganty A, Williams SB. Re: Implementation and Assessment of No Opioid Prescription Strategy at Discharge After Major Urologic Cancer Surgery. Eur Urol 2023; 84:139-140. [PMID: 36967361 PMCID: PMC10625443 DOI: 10.1016/j.eururo.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
The authors prospectively evaluated the implementation of a prespecified protocol to eliminate post-discharge opioid prescription after major urologic cancer surgery at a single center among a predominantly opioid naïve population. The intervention included both provider and patient education along with a standardized regimen for non-opioid analgesia during the inpatient stay and after discharge. Use of a standardized protocol nearly eliminated opioid prescriptions after major urologic cancer surgery without adversely impacting patient reported pain control and satisfaction, unplanned visits, and complications.
Collapse
Affiliation(s)
- Avinash Maganty
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| | - Stephen B Williams
- Division of Urology, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
15
|
Maganty A, Hollenbeck BK, Kaufman SR, Oerline MK, Lai LY, Caram MEV, Shahinian VB. Practice Competition and Treatment of Newly Diagnosed Prostate Cancer. Urology 2023; 177:95-102. [PMID: 37146728 PMCID: PMC10524390 DOI: 10.1016/j.urology.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To examine the effect of urology practice market competition on use of treatment in men with newly diagnosed prostate cancer. METHODS We performed a retrospective national cohort study of 48,067 Medicare beneficiaries with newly diagnosed prostate cancer between 2014 and 2018. The primary exposure was urology practice-level market competition. Markets were established by the flow of patients to a practice using a variable radius approach. Practice level competition was measured annually using the Herfindahl-Hirschman Index. The primary outcome was use of treatment for prostate cancer (ie, surgery, radiation, or cryotherapy) stratified by 10-year risk of noncancer mortality. RESULTS Between 2014 and 2018, there was a decrease in the total percent of urologists practicing in small single-specialty groups (49%-41%) with an increase in multispecialty practices (38%-47%). After adjusting for demographic and clinical characteristics, a lower percentage of men underwent treatment in practices with low competition relative to those managed in practices with high competition (70% vs 67.0%, P < .001). Among men with the highest risk of noncancer mortality, those managed in practices in the least competitive markets were less likely to receive treatment relative to men managed by practices in the most competitive markets (48% vs 60%, P-value<.001). CONCLUSION Reduction in competition between urology practices is not associated with greater use of treatment in men with newly diagnosed prostate cancer, particularly in those with a high risk of noncancer mortality.
Collapse
Affiliation(s)
- Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mary K Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Lillian Y Lai
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Megan E V Caram
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Vahakn B Shahinian
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| |
Collapse
|
16
|
Maganty A, Dunn RL, Bynum JPW, Hollenbeck BK. Accountable care organizations and use of surgery among patients with Alzheimer disease and related dementias. Am J Manag Care 2023; 29:349-355. [PMID: 37523752 PMCID: PMC10403270 DOI: 10.37765/ajmc.2023.89395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To understand the effects of accountable care organizations (ACOs) on use of surgery in patients with Alzheimer disease and related dementias (ADRD). STUDY DESIGN Retrospective national cohort study of all Medicare beneficiaries identified in a 20% sample between 2010 and 2017. The primary exposure was participation in ACOs. The primary outcome was use of 1 of 6 common surgical procedures (aortic valve replacement [AVR], abdominal aortic aneurysm [AAA] repair, colectomy, carotid artery repair, major joint repair, and prostatectomy). METHODS Multivariable logistic regression models were fit using beneficiary-year as the unit of analysis to estimate the likelihood of undergoing each procedure among patients with ADRD and without ADRD, stratified by ACO participation. Additional models were fit to determine how the relationship between ACO participation and surgery was altered based on procedure urgency and the availability of minimally invasive technology. RESULTS Adjusted odds for use of surgery were lower among patients with ADRD compared with patients without ADRD for all procedures. ACO participation had varying impact on patients with ADRD, with higher odds of AVR and major joint surgery and lower odds of carotid artery repair. Availability of minimally invasive technology increased the likelihood of AVR and AAA repair among patients with ADRD; however, ACO participation reduced these effects. The effect of ACO participation on the likelihood of undergoing surgery did not vary by urgency of the procedure. CONCLUSIONS The likelihood of undergoing surgery is overall lower among patients with ADRD and may vary by ACO participation for specific procedures.
Collapse
Affiliation(s)
- Avinash Maganty
- Division of Health Services Research, Department of Urology, University of Michigan, 2800 Plymouth Rd, Bldg 16, Ann Arbor, MI 48109-2800.
| | | | | | | |
Collapse
|
17
|
Maganty A, Byrnes ME, Hamm M, Wasilko R, Sabik LM, Davies BJ, Jacobs BL. Barriers to rural health care from the provider perspective. Rural Remote Health 2023; 23:7769. [PMID: 37196993 DOI: 10.22605/rrh7769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Rural populations routinely rank poorly on common health indicators. While it is understood that rural residents face barriers to health care, the exact nature of these barriers remains unclear. To further define these barriers, a qualitative study of primary care physicians practicing in rural communities was performed. METHODS Semistructured interviews were conducted with primary care physicians practicing in rural areas within western Pennsylvania, the third largest rural population within the USA, using purposively sampling. Data were then transcribed, coded, and analyzed by thematic analysis. RESULTS Three key themes emerged from the analysis addressing barriers to rural health care: (1) cost and insurance, (2) geographic dispersion, and (3) provider shortage and burnout. Providers mentioned strategies that they either employed or thought would be beneficial for their rural communities: (1) subsidize services, (2) establish mobile and satellite clinics (particularly for specialty care), (3) increase utilization of telehealth, (4) improve infrastructure for ancillary patient support (ie social work services), and (5) increase utilization of advanced practice providers. CONCLUSION There are numerous barriers to providing rural communities with quality health care. Barriers that are encountered are multidimensional. Patients are unable to obtain the care they need because of cost-related barriers. More providers need to be recruited to rural areas to combat the shortage and burnout. Advanced care-delivery methods such as telehealth, satellite clinics, or advanced practice providers can help bridge the gaps caused by geographic dispersion. Policy efforts should target all these aspects in order to appropriately address rural healthcare needs.
Collapse
Affiliation(s)
- Avinash Maganty
- Department of Urology, Dow Division of Health Services Research, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mary E Byrnes
- Department of Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Megan Hamm
- Qualitative, Evaluation, and Stakeholder Engagement Research Services, Center for Research on Healthcare's Data Center, University of Pittsburgh, PA, USA
| | - Rachel Wasilko
- Qualitative, Evaluation, and Stakeholder Engagement Research Services, Center for Research on Healthcare's Data Center, University of Pittsburgh, PA, USAQualitative, Evaluation, and Stakeholder Engagement Research Services, Center for Research on Healthcare's Data Center, University of Pittsburgh, PA, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Benjamin J Davies
- Department of Urology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bruce L Jacobs
- Department of Urology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
18
|
Maganty A, Krampe N, Shah AA, Golla V. Merit-based Incentive Payment System Quality Reporting in Urology Practices. Urol Pract 2023; 10:245-252. [PMID: 37103501 PMCID: PMC10140543 DOI: 10.1097/upj.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/31/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Most urologists are required to participate in Merit-based Incentive Payment System-an alternative payment model in which physicians must track and report quality measures. However, Merit-based Incentive Payment System measures are urology-specific, and it remains unclear what measures urologists are choosing to track and report. METHODS We performed a cross-sectional analysis of Merit-based Incentive Payment System measures reported by urologists for the most recent performance year. Urologists were categorized by their reporting affiliation (ie, individual, group, or alternative payment model). We identified the measures most frequently reported by urologists. Among reported measures, we identified those that were specific to urological conditions and those that were "topped out" (ie, measures considered indiscriminate by Medicare because high performance is easily achieved). RESULTS A total of 6,937 urologists reported in Merit-based Incentive Payment System during the 2020 performance year, of whom 14% reported as an individual, 56% as a group, and 30% as an alternative payment model. Among the top 10 most frequently reported measures, none were urology-specific. Eleven percent of urologists reported measures that were directly specific to urological conditions; 65% of individual urologists, 58% of those in groups, and 92% in alternative payment models reported at least 1 or more "topped out" measures. CONCLUSIONS Most measures reported by urologists are not specific to urological conditions, and therefore performance within Merit-based Incentive Payment System may be a poor indicator of the quality of urological care provided. As Medicare transitions Merit-based Incentive Payment System to implement specific quality measures, the urological community will need to develop and submit measures that will be most impactful for urology patients.
Collapse
Affiliation(s)
- Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Noah Krampe
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Anup A Shah
- Division of Urology, Santa Clara Valley Medical Center, San Jose, California
| | - Vishnukamal Golla
- Duke National Clinician Scholars Program, Durham, North Carolina
- Duke Department of Surgery, Division of Urology, Durham, North Carolina
- Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Section of Urology, Durham Veterans Affairs Health Care System, Durham, North Carolina
| |
Collapse
|
19
|
Lai LY, Kaufman SR, Oerline M, Caram ME, Maganty A, Shahinian VB, Hollenbeck BK. Effects of In-office Dispensing by Single-specialty Urology Practices on Management of Advanced Prostate Cancer. Urol Pract 2023; 10:230-235. [PMID: 37103497 PMCID: PMC10154036 DOI: 10.1097/upj.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/15/2023] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We examine changes in the volume of patients with advanced prostate cancer and prescriptions for abiraterone and enzalutamide among urology practices with and without in-office dispensing. METHODS Using data from the National Council for Prescription Drug Programs, we identified in-office dispensing by single-specialty urology practices from 2011 to 2018. As the greatest growth in implementing dispensing occurred among large groups in 2015, outcomes were measured at the practice level in 2014 (before) and 2016 (after) for dispensing and non-dispensing practices. Outcomes included the volume of men with advanced prostate cancer managed by a practice and prescriptions for abiraterone and/or enzalutamide. Using national Medicare data, generalized linear mixed models were fit to compare the practice-level ratio of each outcome (2016 relative to 2014) adjusting for regional contextual factors. RESULTS In-office dispensing increased from 1% to 30% of single-specialty urology practices from 2011 to 2018, with 28 practices implementing dispensing in 2015. In 2016 compared to 2014, adjusted changes in the volume of patients with advanced prostate cancer managed by a practice were similar between non-dispensing (0.88, 95% CI 0.81-0.94) and dispensing (0.93, 95% CI 0.76-1.09) practices (P = .60). Prescriptions for abiraterone and/or enzalutamide increased in both non-dispensing (2.00, 95% CI 1.58-2.41) and dispensing (8.99, 95% CI 4.51-13.47) practices (P < .01). CONCLUSIONS In-office dispensing is increasingly common in urology practices. This emerging model is not associated with changes in patient volume but is associated with increased prescriptions for abiraterone and enzalutamide.
Collapse
Affiliation(s)
- Lillian Y. Lai
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Samuel R. Kaufman
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Mary Oerline
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Megan E.V. Caram
- Veterans Affairs Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Avinash Maganty
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Vahakn B. Shahinian
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, United States
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Brent K. Hollenbeck
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, United States
| |
Collapse
|
20
|
Maganty A, Hollenbeck BK, Kaufman SR, Oerline MK, Lai LY, Caram MEV, Shahinian VB. Implications of the Merit-Based Incentive Payment System for Urology Practices. Urology 2022; 169:84-91. [PMID: 35932872 PMCID: PMC9669102 DOI: 10.1016/j.urology.2022.05.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the implications of the merit-based incentive payment system (MIPS) for urology practices. MIPS is a Medicare payment model that determines whether a physician is financially penalized or receives bonus payment based on performance in four categories: quality, practice improvement, promotion of interoperability, and spending. METHODS We performed a cross-sectional analysis of urologist performance in MIPS for 2017 and 2019 using Medicare data. Urologist practice organization was categorized as single-specialty (small, medium, large) or multispecialty groups. MIPS scores were estimated by practice organization. Logistic regression models were used to examine the association between urology practice characteristics, including proportion of dual eligible beneficiaries, and bonus payment adjustment as defined by Medicare methodology. Rates of consolidation (movement from smaller to larger practices) between 2017 and 2019 were compared between those who were and those who were not penalized in 2017. RESULTS Urologists in small practices performed worse in MIPS and had a significantly lower adjusted odds ratio of receiving bonus payments in both 2017 and 2019 compared to larger group practices (odds ratio [OR] 0.04, 95% confidence interval [95%CI] 0.03-0.05 in 2017 and OR 0.37, 95%CI 0.30-0.47 in 2019). Increasing percent of dual eligible beneficiaries within a patient panel was associated with decreased odds of receiving bonus payment in both performance years. Urologists penalized in 2017 had higher rates of consolidation by 2019 compared to those who were not (14% vs 5%, P <.05). CONCLUSION Small urology practices and those caring for a higher proportion of dual eligible beneficiaries tended to perform worse in MIPS.
Collapse
Affiliation(s)
- Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI.
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI
| | - Mary K Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI
| | - Lillian Y Lai
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI
| | - Megan E V Caram
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI
| | - Vahakn B Shahinian
- Dow Division of Health Services Research, Department of Urology, University of Michigan, MI; Division of Nephrology, Department of Internal Medicine, University of Michigan, MI
| |
Collapse
|
21
|
Ayyash O, Yabes J, Hugar L, Maganty A, Williams SB, Wulff-Burchfield E, Davies B, Jacobs B. New Mental Health Diagnosis as a Prognostic Factor for Muscle-Invasive Bladder Cancer. Clin Genitourin Cancer 2022; 21:e1-e8. [PMID: 36446679 DOI: 10.1016/j.clgc.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND To examine differences in survival outcomes for muscle-invasive bladder cancer patients stratified by new mental health diagnosis. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients diagnosed with muscle-invasive bladder cancer between 2008 and 2014. Our primary outcome was cancer-specific and overall hazards of mortality. As a secondary outcome, we reported predictors of developing a new mental health diagnosis after bladder cancer diagnosis. We used Cox proportional hazards models to determine the impact of palliative care and mental health diagnoses on survival outcomes after adjusting for grade, stage, comorbidity index, and baseline demographics. RESULTS Of the 3794 patients who met inclusion criteria, 1193 (31%) were diagnosed with a mental health illness after their bladder cancer diagnosis during the 6 years in the study period. The most common diagnoses were depression (13%), alcohol and drug abuse (12%), and anxiety (11%). Patients with a post-bladder cancer mental health diagnosis had a 57% higher hazard of overall mortality (HR 1.57, P = .048) and an 80% higher hazard of bladder cancer-specific mortality (HR 1.81, P = .037) CONCLUSIONS: New mental health diagnoses are associated with worse survival in patients with muscle invasive bladder cancer. This suggests that a multimodal approach to bladder cancer treatment should include addressing the non-oncologic needs of the patient to optimize survival outcomes.
Collapse
Affiliation(s)
- Omar Ayyash
- Department of Urology, UPMC, Pittsburgh, PA.
| | - Jonathan Yabes
- Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lee Hugar
- Department of Urology, UPMC, Pittsburgh, PA
| | | | - Stephen B Williams
- Department of Surgery, Division of Urology, University of Texas Medical Branch, Galveston, TX
| | - Elizabeth Wulff-Burchfield
- Division of Medical Oncology and Palliative Medicine, University of Kansas Medical Center, Kansas City, KS
| | | | | |
Collapse
|
22
|
Maganty A, Hollenbeck BK. Analyzing Trends in Urethral Suspension Procedures After Changes in Medicare Payment Policy. JAMA Netw Open 2022; 5:e2233646. [PMID: 36194417 DOI: 10.1001/jamanetworkopen.2022.33646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| |
Collapse
|
23
|
Jones CA, Pekala KR, Armann KM, Maganty A, Yabes JG, Bandari J, Yu M, Davies BJ, Jacobs BL. Opioid-Free Ureteroscopy: Are Academic Urologists Lagging Behind Private Practice? Urology 2022; 167:56-60. [PMID: 35780945 DOI: 10.1016/j.urology.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/11/2022] [Accepted: 06/05/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine overall trends in opioid prescribing after ureteroscopy and compared opioid use between private and academic practice settings. We also analyzed the potential for spillover effect from an unrelated opioid-reduction initiative for major oncologic surgery. METHODS We conducted a retrospective chart review of all ureteroscopies performed within our system at four distinct time points from 2016-2019. We recorded the type and number of opioid pills prescribed and calculated oral morphine equivalents. Analysis included comparison between community and academic hospitals as well as pre- and post-initiative. RESULTS 555 patients undergoing ureteroscopy and 29 attending surgeons were included in the analysis. The median prescription size per ureteroscopy decreased throughout the study period in both the private and academic settings. From 2016-2017, median oral morphine equivalents (OMEs) decreased from 60 to 0 in the private setting and remained at 0 for the duration of the study period. Opioid reduction in the academic setting lagged behind private practitioners but median OMEs did steadily decrease to 0 in 2019. No significant spillover effect was observed. CONCLUSION Since 2016, opioid prescribing following ureteroscopy has decreased in both the private and academic practice settings. Notably, private practice urologists achieved a median of 0 opioids 2 years prior to academic urologists. These data suggest that, in some circumstances, academic institutions may have been slower to respond to the opioid epidemic.
Collapse
Affiliation(s)
| | | | - Kody M Armann
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Jonathan G Yabes
- Center for Research on Health Care, Pittsburgh, PA; UPMC Division of General Internal Medicine, Pittsburgh, PA
| | | | | | | | | |
Collapse
|
24
|
Maganty A, Herrel LA, Hollenbeck BK. Robotic Surgery for Bladder Cancer. JAMA 2022; 327:2085-2087. [PMID: 35569078 DOI: 10.1001/jama.2022.6417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Avinash Maganty
- Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Lindsey A Herrel
- Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| | - Brent K Hollenbeck
- Dow Division for Health Services Research, Department of Urology, University of Michigan, Ann Arbor
| |
Collapse
|
25
|
Miller D, Pekala K, Zhang X, Orikogbo O, Rogers D, Fuller TW, Maganty A, Rusilko P. Outcomes of Initial Transcorporal Versus Standard Placement of Artificial Urinary Sphincter in Patients With Prior Radiation. Cureus 2022; 14:e25519. [PMID: 35800826 PMCID: PMC9246464 DOI: 10.7759/cureus.25519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/29/2022] [Indexed: 11/05/2022] Open
|
26
|
Hacker EC, Maganty A, Pere MM, Rusilko PJ. Outcomes of Vesicourethral Anastomotic Stenosis and Bladder Neck Contracture with Direct Visual Internal Urethrotomy with Mitomycin-C After Prostate Cancer Treatment. Urology 2022; 165:331-335. [DOI: 10.1016/j.urology.2022.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 12/22/2022]
|
27
|
Lai LY, Kaufman SR, Oerline MK, Caram MEV, Maganty A, Hollenbeck BK, Shahinian VB. OUP accepted manuscript. JNCI Cancer Spectr 2022; 6:6544596. [PMID: 35603854 PMCID: PMC8973404 DOI: 10.1093/jncics/pkac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/22/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
Urologists are increasingly prescribing oral targeted therapies to patients with advanced prostate cancer. Concurrent with this trend, urology practices are allowing patients to fill their prescription onsite or through a pharmacy established by the practice. We examined prescription patterns for abiraterone or enzalutamide between eventually dispensing single-specialty urology practices, nondispensing single-specialty urology practices, and multispecialty practices using a 20% random sample of the 2013-2017 national Medicare claims. We determined physician dispensing through manual search of publicly available information. From 2015 through 2017, higher percentages of patients managed by eventually dispensing single-specialty urology practices had a filled prescription of abiraterone or enzalutamide compared with patients managed in nondispensing single-specialty urology practices (eg, in 2017, 8.9%, 95% confidence interval = 7.3% to 10.9%, vs 5.9%, 95% confidence interval = 5.0% to 7.0%, respectively; 2-sided P < .001). Insofar as physician dispensing is associated with higher use of abiraterone or enzalutamide, it may represent a means to improve treatment access.
Collapse
Affiliation(s)
- Lillian Y Lai
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Correspondence to: Lillian Y. Lai, MD, MS, Department of Urology, University of Michigan, 2800 Plymouth Road, Bldg 16, Ann Arbor, MI 48109-2800, USA (e-mail: )
| | - Samuel R Kaufman
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Mary K Oerline
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Megan E V Caram
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- VA Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Avinash Maganty
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Vahakn B Shahinian
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
28
|
Jackman SV, Maganty A, Wolfson AB, Burrows PK, MacPherson C, Vargas NM, Kirkali Z, Meltzer AC. Resolution of Hydronephrosis and Pain to Predict Stone Passage for Patients With Acute Renal Colic. Urology 2021; 159:48-52. [PMID: 34627871 DOI: 10.1016/j.urology.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To study patients who presented to the Emergency Department with acute renal colic to determine if resolution of hydronephrosis and pain accurately predicts stone passage on follow-up CT. MATERIALS AND METHODS This is a secondary analysis of a multicenter prospective randomized clinical trial of patients diagnosed by computed tomography (CT) scan with a symptomatic ureteral stone < 9 mm in diameter. Participants were followed after randomization to evaluate for analgesic use and to assess stone passage and hydronephrosis on a repeat CT scan obtained at 29-36 days. RESULTS Four-hundred-three patients were randomized in the original study and patients were included in this analysis if they did not have surgery for stone removal and had a CT scan and information on pain medication at follow-up (N = 220). Hydronephrosis was detected in 181 (82%) on initial CT. At follow-up CT, 43 (20%) participants had a persistent ureteral stone. Of these patients, 36 (84%) had no pain, 26 (60%) did not have hydronephrosis, and 23 (53%) had neither pain nor hydronephrosis. Resolution of hydronephrosis was associated with stone passage (RR 4.6, 95% CI 1.9, 11.0), while resolution of pain was not (RR 1.1, 95% CI 0.9, 1.4). CONCLUSION In patients with urinary stone disease, stone passage is associated with resolution of hydronephrosis but not resolution of pain. In patients with persistent ureteral stones, neither pain nor hydronephrosis are consistently present. These findings have important implications on follow-up imaging of patients with urinary stone disease.
Collapse
Affiliation(s)
- Stephen V Jackman
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Allan B Wolfson
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Pamela K Burrows
- The George Washington University Biostatistics Center, Rockville, MD
| | - Cora MacPherson
- The George Washington University Biostatistics Center, Rockville, MD
| | - Nataly Montano Vargas
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Andrew C Meltzer
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.
| |
Collapse
|
29
|
Hacker EC, Maganty A, Pere MM, Rusilko PJ. MP03-20 OUTCOMES OF DIRECT VISUAL INTERNAL URETHROTOMY WITH MITOMYCIN-C (DVIU-MMC) IN BLADDER NECK CONTRACTURE (BNC) AND VESICOURETHRAL ANASTOMOSIS STRICTURE (VUAS) FOLLOWING PROSTATE CANCER TREATMENT. J Urol 2021. [DOI: 10.1097/ju.0000000000001964.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Maganty A, Yu M, Anyaeche VI, Zhu T, Hay JM, Davies BJ, Yabes JG, Jacobs BL. Referral pattern for urologic malignancies before and during the COVID-19 pandemic. Urol Oncol 2021; 39:268-276. [PMID: 33308974 PMCID: PMC7722486 DOI: 10.1016/j.urolonc.2020.11.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/29/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has required significant restructuring of healthcare with conservation of resources and maintaining social distancing standards. With these new initiatives, it is conceivable that the diagnosis of cancer care may be delayed. We aimed to evaluate differences in patient populations being evaluated for cancer before and during the COVID-19 pandemic. METHODS AND MATERIALS We performed a retrospective review of our electronic medical record and examined patient characteristics of those presenting for a possible new cancer diagnosis to our urologic oncology clinic. Data was analyzed using logistic and linear regression models. RESULTS During the 3-month period before the COVID-19 pandemic began, 585 new patients were seen in one urologic oncology practice. The following 3-month period, during the COVID-19 pandemic, 362 patients were seen, corresponding to a 38% decline. Visits per week increased to pre-COVID-19 levels for kidney and bladder cancer as the county entered the green phase. Prostate cancer visits per week remained below pre-COVID-19 levels in the green phase. When the 2 populations pre-COVID-19 and COVID-19 were compared, there were no notable differences on regression analysis. CONCLUSION The COVID-19 pandemic decreased the total volume of new patient referrals for possible genitourinary cancer diagnoses. The impact this will have on cancer survival remains to be determined.
Collapse
Affiliation(s)
- Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA,Corresponding author. Tel.: 480-292-0661
| | - Michelle Yu
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Vivian I. Anyaeche
- School of Medicine, University of Pittsburgh, Pittsburgh Medical Center, Pittsburgh, PA
| | - Toby Zhu
- School of Medicine, University of Pittsburgh, Pittsburgh Medical Center, Pittsburgh, PA
| | - Jordan M. Hay
- School of Medicine, University of Pittsburgh, Pittsburgh Medical Center, Pittsburgh, PA
| | - Benjamin J. Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jonathan G. Yabes
- Division of Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Bruce L. Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
31
|
Pekala K, Miller D, Fuller T, Orikogbo O, Rogers D, Maganty A, Rusilko P. 111 First-time Transcorporal vs Standard Artificial Urinary Sphincter Placement in Patients with Prior Tadiation for Prostate Cancer: A Comparison of Outcomes. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
32
|
Jacobs BL, Rogers D, Yabes JG, Bandari J, Ayyash OM, Maganty A, Armann KM, Worku HA, Pace NM, Shah A, Pekala KR, Yu M, Chelly JE, Macleod LC, Davies BJ. Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery. Cancer 2020; 127:257-265. [PMID: 33002197 DOI: 10.1002/cncr.33200] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/15/2020] [Accepted: 06/04/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surgeons play a pivotal role in combating the opioid crisis that currently grips the United States. Changing surgeon behavior is difficult, and the degree to which behavioral science can steer surgeons toward decreased opioid prescribing is unclear. METHODS This was a single-institution, single-arm, pre- and postintervention study examining the prescribing of opioids by urologists for adult patients undergoing prostatectomy or nephrectomy. The primary outcome was the quantity of opioids prescribed in oral morphine equivalents (OMEs) after hospital discharge. The primary exposure was a multipronged behavioral intervention designed to decrease opioid prescribing. The intervention had 3 components: 1) formal education, 2) individual audit feedback, and 3) peer comparison performance feedback. There were 3 phases to the study: a pre-intervention phase, an intervention phase, and a washout phase. RESULTS Three hundred eighty-two patients underwent prostatectomy, and 306 patients underwent nephrectomy. The median OMEs decreased from 195 to 19 in the prostatectomy patients and from 200 to 0 in the nephrectomy patients (P < .05 for both). The median OMEs prescribed did not increase during the washout phase. Prostatectomy patients discharged with opioids had higher levels of anxiety than patients discharged without opioids (P < .05). Otherwise, prostatectomy and nephrectomy patients discharged with and without opioids did not differ in their perception of postoperative pain management, activity levels, psychiatric symptoms, or somatic symptoms (P > .05 for all). CONCLUSIONS Implementing a multipronged behavioral intervention significantly reduced opioid prescribing for patients undergoing prostatectomy or nephrectomy without compromising patient-reported outcomes.
Collapse
Affiliation(s)
- Bruce L Jacobs
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Devin Rogers
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan G Yabes
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Omar M Ayyash
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kody M Armann
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hermoon A Worku
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Natalie M Pace
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anup Shah
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kelly R Pekala
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle Yu
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacques E Chelly
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Liam C Macleod
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
33
|
Miller DT, Maganty A, Theisen KM, Hrebinko R. Novel Creation of a Noneverted Stoma During Ileal Conduit Urinary Diversion: Technique and Short-term Outcomes. Urology 2020; 146:260-264. [PMID: 32791293 DOI: 10.1016/j.urology.2020.07.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report our experience with a noneverted stoma technique used in ileal conduit urinary diversion. We successfully utilize this technique in patients when traditional everted stoma maturation is difficult due to a thick abdominal wall, bulky mesentery, and poor bowel compliance. METHODS We retrospectively reviewed all patients who underwent surgical creation of ileal conduit using a noneverted stoma technique between 2009 and 2018. We recorded demographic and perioperative information, including 30-day postoperative complications, and stoma appearance at last follow-up visit. Using R software, chi-square testing of the distribution of stoma outcomes for obese and nonobese patients was performed. RESULTS There were a total of 42 patients who underwent noneverted stoma maturation technique by a single surgeon. Our cohort meets obese criteria with a mean body mass index (BMI) of 30.2. Mean length of follow-up was 16.6 months (1-62). On follow-up, 35 (83.3%) of stomas were pink and everted appearing, 4 (9.5%) were flush, small, or noneverted, 1 (2.3%) had an eschar or area of granulation tissue around the stoma, and 2 (4.7%) did not have a stoma description documented. There were 9 (21%) stoma-related complications in our cohort. There was no statistical difference in stoma outcomes between obese (BMI > 30) and nonobese (BMI < 30) patients (P= .65). CONCLUSION Ileal conduit creation with a noneverted stoma provides good stoma protuberance in patients with a thick abdominal wall, bulky mesentery, and poor bowel compliance. This technique is safe and should be considered in patients in whom stoma maturation is difficult.
Collapse
Affiliation(s)
- David T Miller
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Katherine M Theisen
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ronald Hrebinko
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
34
|
Pace NM, Maganty A, Siripong N, Lee AJ, Huang D, Bandari J, Jacobs BL, Davies BJ. Gender Gap in Industry Relationships and Scholarly Impact Among Academic Urologists in the United States. Urology 2020; 139:90-96. [DOI: 10.1016/j.urology.2020.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/09/2020] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
|
35
|
Maganty A, Turner RM, Yabes JG, Heron DE, Gingrich JR, Davies BJ, Jacobs BL. Increasing use of positron emission tomography among medicare beneficiaries undergoing radical cystectomy. Eur J Cancer Care (Engl) 2020; 29:e13230. [PMID: 32026559 DOI: 10.1111/ecc.13230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 12/13/2019] [Accepted: 01/12/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine factors associated with PET scan use in the pre-operative evaluation of patients diagnosed with bladder cancer. METHODS Using SEER-Medicare data, we identified bladder cancer patients who underwent radical cystectomy from 2006 to 2011 (n = 4,138). The primary outcome was PET scan use within 6 months before surgery. To examine predictors of PET scan use, we fit a mixed logit model with health service area as a random effect to account for patients nested within health service areas. We also calculated the adjusted probability of use over time and examined variation among the highest volume surgeons. RESULTS Among the 4,138 patients, 406 (10%) received a pre-operative PET scan. The adjusted probability of a patient undergoing a PET scan increased from 0.04 in 2004 to 0.10 in 2011 (p < .001). Among the 78 highest volume surgeons, there was significant variation in PET scan use (p < .001). Patients with non-urothelial histology, measurement of alkaline phosphatase levels, and receipt of neoadjuvant chemotherapy were more likely to receive PET scan (all p < .05). CONCLUSION Use of PET prior to radical cystectomy doubled over a 5-year period, suggesting its increased use in patients with muscle-invasive bladder cancer, particularly those with high-risk disease. Whether its use is warranted and improves patient outcomes is not clear and requires further studies.
Collapse
Affiliation(s)
- Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert M Turner
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan G Yabes
- Division of Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
36
|
Pekala K, Pelzman D, Maganty A, Rogers D, Theisen K, Fuller T, Rusilko P. Prevalence of Penile Cancer in Patients with Adult Acquired Buried Penis. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
37
|
Pekala KR, Pelzman D, Theisen KM, Rogers D, Maganty A, Fuller TW, Rusilko PJ. The Prevalence of Penile Cancer in Patients With Adult Acquired Buried Penis. Urology 2019; 133:229-233. [PMID: 31369750 DOI: 10.1016/j.urology.2019.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the prevalence of penile cancer in patients with adult acquired buried penis (AABP). Penile cancer is a rare but aggressive cancer. Several case reports have recently been published that indicate that AABP may increase the risk of penile cancer. MATERIALS AND METHODS A retrospective review was conducted of adults diagnosed with AABP and penile cancer between January, 2008 and December, 2018 seen at a tertiary referral center. Demographics including age, BMI, comorbidities, etiology of AABP, smoking history, circumcision status, and premalignant lesions (condyloma, lichen sclerosus [LS] carcinoma in situ [CIS]) were recorded. For patients with penile cancer, AJCC staging, grade, TNM staging and treatments were recorded. Basic descriptive statistics were performed for the overall cohort. We used Chi-square tests and Fisher exact tests to compare differences between patients with benign pathology and patients with malignant or pre-malignant pathology. RESULTS We identified 150 patients with the diagnosis of AABP. The prevalence of penile squamous cell carcinoma was 7%. There was a 35% rate of premalignant lesions. This study is limited by its retrospective and single-institution nature. CONCLUSION AABP is a condition that incorporates multiple risk factors for penile cancer. The prevalence of penile cancer appears to be higher in patients with AABP; however, more data are needed to confirm these initial findings. Patients with AABP should be counseled on these risks and should be considered for buried penis repair if a physical examination cannot be performed.
Collapse
Affiliation(s)
- Kelly R Pekala
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Daniel Pelzman
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Katherine M Theisen
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Devin Rogers
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas W Fuller
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Paul J Rusilko
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA
| |
Collapse
|
38
|
Macleod LC, Yabes JG, Fam MM, Bandari J, Yu M, Maganty A, Furlan A, Filson CP, Davies BJ, Jacobs BL. Multiparametric Magnetic Resonance Imaging Is Associated with Increased Medicare Spending in Prostate Cancer Active Surveillance. Eur Urol Focus 2019; 6:242-248. [PMID: 31031042 DOI: 10.1016/j.euf.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) may improve prostate cancer risk stratification and decrease the need for repeat biopsies in men on prostate cancer active surveillance (AS). However, the impact of mpMRI on AS-related healthcare spending has not been established. OBJECTIVE To characterize the impact of mpMRI on AS-related Medicare expenditures. DESIGN, SETTING, AND PARTICIPANTS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare files, we identified men ≥66 yr old with localized prostate cancer diagnosed during 2008-2013. OUTCOME MEASURES AND STATISTICAL ANALYSIS With a validated algorithm, we classified men into AS with and without mpMRI groups. We then determined Medicare spending on AS in each group using inflation-adjusted, price-standardized Medicare payments for AS-related procedures (ie, prostate-specific antigen [PSA] tests, prostate biopsies, biopsy complications, and mpMRI). Multivariable median regression compared Medicare spending on AS for men who received mpMRI and those who did not. RESULTS AND LIMITATIONS We identified 9081 men on AS with a median follow-up of 45 mo (interquartile range 29-64 mo). Thirteen percent (N = 1225) received mpMRI. On multivariable median regression, receipt of mpMRI was associated with an additional $447 (95% confidence interval $409-487) in Medicare spending per year. We observed greater frequency of AS-related procedures and higher spending for identical procedures (eg, PSA or prostate biopsy) in the mpMRI group than in the non-mpMRI group (all p < 0.001). CONCLUSIONS Among Medicare beneficiaries on AS, mpMRI is associated with additional annual Medicare spending. Future studies are needed to determine optimal use of mpMRI during AS to maximize value. PATIENT SUMMARY Prostate magnetic resonance imaging (MRI) helps physicians determine which prostate cancers are aggressive and which can be monitored safely. We studied whether using MRI during prostate cancer monitoring (also called active surveillance) resulted in increased healthcare spending. There was a modest increase in spending, but this may be worthwhile if the use of MRI allows physicians to monitor prostate cancer more accurately.
Collapse
Affiliation(s)
- Liam C Macleod
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mina M Fam
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michelle Yu
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
39
|
Maganty A, Turner RM, Yabes JG, Davies BJ, Heron DE, Jacobs BL. Downstream Studies Following the Use of Bone Scan in the Staging of Muscle-invasive Bladder Cancer. Urology 2019; 129:74-78. [PMID: 31005656 DOI: 10.1016/j.urology.2019.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/04/2019] [Accepted: 04/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To quantify the use of downstream studies following staging bone scans in patients with muscle-invasive bladder cancer. Bone scans may be obtained in high-risk bladder cancer patients prior to radical cystectomy to exclude bone metastases. However, false-positive bone scans can occur, resulting in the need for additional studies. PATIENTS AND METHODS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified 4404 patients diagnosed with muscle-invasive bladder cancer from 2004 to 2011. We further identified those who underwent a bone scan prior to treatment within 6 months of diagnosis and prior to any treatment with cystectomy, radiotherapy, or chemotherapy. We determined the proportion of patients who underwent a subsequent study (bone X-ray, bone CT, bone MRI, and/or bone biopsy) within 3 months of the bone scan and prior to treatment. RESULTS Among patients diagnosed with muscle-invasive bladder cancer, 1373 (31%) had a staging bone scan of whom 26% received a downstream study (n = 213). Overall, 61 patients (7%) received downstream bone-specific X-rays, more than 141 patients (>17%) received bone-specific CTs, and 28 patients (3%) received bone-specific MRIs. The use of bone biopsy was rare (n < 11; <1%). The total cost of all downstream studies was $103,468. Furthermore, there was a one-month delay in treatment for those who received a downstream study compared to those who did not (P < 0.001). CONCLUSION Use of bone scan in the staging of muscle-invasive bladder cancer often results in the need for additional downstream studies. The delay in treatment and cost burden of downstream studies highlights a potential disadvantage of the routine use of this staging modality.
Collapse
Affiliation(s)
- Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Robert M Turner
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jonathan G Yabes
- Division of Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
40
|
Maganty A, Yu M, Macleod LC, Yabes JG, Fam MM, Bandari J, Turner R, Furlan A, Filson CP, Davies BJ, Jacobs BL. Increasing utilization of multi-parametric magnetic resonance imaging in prostate cancer active surveillance. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
125 Background: Multi-parametric resonance imaging (mpMRI) has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established. Therefore, we sought to characterize the use of multiparametric magnetic resonance imaging (mpMRI) in Medicare beneficiaries electing active surveillance for prostate cancer. Methods: SEER-Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008-2013 and managed with active surveillance. We classified men into two treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI. Results: We identified 9,467 men on active surveillance. Of these, 8,178 (86%) did not receive mpMRI and 1,289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (p = 0.004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all p < 0.05). Conclusions: From 2008-2013, use of mpMRI in active surveillance increased gradually but significantly. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic, geographic and socioeconomic strata. Going forward, studies should investigate causes for this variation and define ideal strategies for equitable, cost-effective dissemination of mpMRI technology.
Collapse
Affiliation(s)
| | - Michelle Yu
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Mina M Fam
- Jersey Shore University Medical Center, Neptune, NJ
| | | | - Robert Turner
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | | |
Collapse
|
41
|
Yu M, Maganty A, Macleod LC, Yabes JG, Fam MM, Bandari J, Furlan A, Turner R, Filson CP, Davies BJ, Jacobs BL. Cost implications of multi-parametric magnetic resonance imaging in prostate cancer active surveillance. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
65 Background: Multi-parametric resonance imaging (mpMRI) has emerged to improve disease risk-stratification and decrease number of repeat biopsies in men on prostate cancer active surveillance (AS). However, the impact of mpMRI on cost of AS has not been established. We thus characterize the impact mpMRI on cost of AS in the Medicare population. Methods: Using SEER-Medicare files we identified men ≥66 years old with localized grade group I-II prostate cancer diagnosed 2008-2013. With an established algorithm, we classified men into active surveillance with and without mpMRI. We then determined cost of surveillance in each group using inflation-adjusted Medicare payments for surveillance-related procedures and their sequalae (i.e. PSA tests, prostate biopsies, post-biopsy complications and mpMRIs). Multivariable median regression compared cost and procedural-intensity for men who received mpMRI and those who did not. Results: We identified 9,081 men on AS with median follow up 45 months (IQR 29-64 months). 7,856 (87%) men did not receive mpMRI and 1,225 (13%) did. On multivariable median regression, receipt of mpMRI was associated with an additional $449 (95%CI $391-$507) in Medicare payments per year. Younger age, treatment in the west or northeast, greater population density and treatment later in the study period were associated with increased cost of AS. Conclusions: Among Medicare beneficiaries on AS, mpMRI is associated with additional annual cost to Medicare. MpMRI may be a marker of more stringent AS, which is likely more costly than watchful waiting. Future studies are needed to determine optimal use of mpMRI during AS to maximize value.
Collapse
Affiliation(s)
- Michelle Yu
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | - Mina M Fam
- Jersey Shore University Medical Center, Neptune, NJ
| | | | | | - Robert Turner
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | |
Collapse
|
42
|
Bandari J, Maganty A, Davies BJ. Editorial Comment. Urology 2019; 124:125-126. [DOI: 10.1016/j.urology.2018.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
Bandari J, Maganty A, MacLeod LC, Davies BJ. Manufacturing and the Market: Rationalizing the Shortage of Bacillus Calmette-Guérin. Eur Urol Focus 2018; 4:481-484. [DOI: 10.1016/j.euf.2018.06.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/15/2018] [Accepted: 06/28/2018] [Indexed: 11/28/2022]
|
44
|
Morgan TN, Shahait M, Maganty A, Ost M, Jackman S, Averch T, Semins MJ. Conservative Management of Staghorn Calculi: When Is It Safe? J Endourol 2018; 32:541-545. [DOI: 10.1089/end.2018.0002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Mohammad Shahait
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Ost
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen Jackman
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy Averch
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
45
|
Morgan TN, Shahait M, Maganty A, Ost M, Jackman S, Averch T, Semins MJ. Response to Hamilton et al. re: Conservative Management of Staghorn Calculi: When Is It Safe? by Morgan et al. J Endourol 2018; 32:547. [PMID: 29782190 DOI: 10.1089/end.2018.29038.mor] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Mohammad Shahait
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Ost
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen Jackman
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy Averch
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
46
|
Maganty A, Correa A, Bandari J, Hrebinko R, Davies B, Maranchie J, Jackman S. MP48-08 ONCOLOGIC OUTCOMES OF SIMPLE ENUCLEATION PARTIAL NEPHRECTOMY IN SPORADIC TYPE 2 PAPILLARY RENAL CELL CARCINOMA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
47
|
Osterberg EC, Schulster M, Blaivas JG, Maganty A, Lee DJ, Purohit RS. Urethroplasty Improves Overactive Bladder Symptoms in Men With Anterior Urethral Strictures. Urology 2016; 93:208-12. [PMID: 27063611 DOI: 10.1016/j.urology.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the effect of urethroplasty on overactive bladder (OAB) symptoms. MATERIALS AND METHODS From March 2011 to November 2014, 47 anterior urethroplasties were performed by a single surgeon (RSP). Of these, 42 men prospectively completed the validated Overactive Bladder Symptom Score (OABSS) prior to and after urethroplasty. Comparative analysis of preoperative to postoperative OABSS results was performed. RESULTS The median (range) age of men who comprised our cohort was 49 (22-90). Questionnaires were completed preoperatively and at a median of 12 months (2.3-74.6) postoperatively. Stricture location included the following: bulbar (75%), penile (15%), and membranous (7.5%) urethra. Median stricture length was 3 cm (1-6). Half of the men underwent an excision and anastomotic repair, and half underwent buccal mucosal graft. Men experienced significant improvement in urinary flow rate, postvoid residual urine, and OAB symptoms reported on the OABSS. Of the 28/42 men with preoperative, clinically significant OAB (ie, OABSS ≥ 8), 25/28 reported a 54.2% (0%-100%) median reduction in OABSS, with only 1 patient reporting worsening of symptoms following surgery. Those men with the highest preoperative OABSS experienced the greatest improvement in OAB symptoms postoperatively. CONCLUSION In men with anterior urethral strictures and OAB, urethroplasty decreased reported OABSS by >50% and cured 90% of men with clinically significant OAB symptoms.
Collapse
Affiliation(s)
| | | | - Jerry G Blaivas
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Daniel J Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | | |
Collapse
|
48
|
Abstract
Numerous studies have sought to examine the relationship between hypogonadal symptoms and total serum testosterone levels in men in order to identify a threshold at which symptoms occur and at which treatment is beneficial. However, the search for a discrete threshold may be futile given emerging evidence. Recent studies suggest that testosterone threshold varies by symptoms and among individuals. In addition, thresholds may vary between young and old men. Therefore, initiation of treatment should rely more on symptoms and less on a discrete numerical threshold.
Collapse
Affiliation(s)
- Avinash Maganty
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College , New York, NY , USA and
| | | | | |
Collapse
|
49
|
Abstract
Testosterone replacement therapy (TRT) use is increasing, primarily in men with symptomatic hypogonadism. There are many benefits associated with TRT use, including improved sexual function, improved bone mineral density, and increased free fat mass and strength. As TRT use increases, its role on cardiovascular health must be explored. While previous evidence identified no adverse cardiovascular risks associated with TRT use, more recent studies suggest that there may be an associated risk, especially in elderly men and younger men with cardiac disease. Care must be taken with TRT use in these groups of men by careful monitoring for cardiac dysfunction. While testosterone therapy has many benefits and may generally be well tolerated, those prescribing the therapy must be cognizant of the potential adverse cardiovascular risks and advise men on the potential risks versus benefits.
Collapse
Affiliation(s)
- Avinash Maganty
- New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - E Charles Osterberg
- New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | | |
Collapse
|
50
|
Abstract
The use of testosterone supplementation therapy (TST) is increasing primarily in men with symptomatic hypogonadism. While TST has been shown to have numerous benefits, as its use increases, the role on cardiovascular health must be explored. Previous evidence showed no adverse cardiovascular risks associated with TST use; however, more recent studies suggest that there may be an associated risk. The exact mechanism by which TST may contribute to cardiovascular risk has not been elucidated. Numerous mechanisms have been proposed which include testosterone's effect on thromboxane A2 receptors, vascular adhesion molecule 1 receptors, erythropoiesis, and obstructive sleep apnea, all of which can ultimately lead to atherogenesis and increased cardiovascular risk.
Collapse
Affiliation(s)
- Avinash Maganty
- Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jason R Kovac
- Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ranjith Ramasamy
- Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA
| |
Collapse
|